A new national study involving researchers from Oxford will investigate the long-term effects of lung inflammation and scarring from COVID-19.
The study, launched with £2 million of funding from UK Research and Innovation (UKRI), aims to develop treatment strategies and prevent disability.
Many people recovering from COVID-19 suffer from long-term symptoms of lung damage, including breathlessness, coughing, fatigue and limited ability to exercise.
COVID-19 can lead to inflammation in the lungs due to the infection and the immune system’s reaction to it. The inflammation may improve over time, but in some people it persists.
In severe cases, the lungs may become scarred. The scarring causes stiffness in the lungs, which can make it difficult to breathe and get oxygen to the bloodstream, resulting in long-term breathlessness and difficulty managing daily tasks.
This inflammation and scarring of the lungs is called ‘interstitial lung disease’.
Now, this study, called the UK Interstitial Lung Disease Long-COVID19 (UKILD-Long COVID) study, will investigate whether post-COVID-19 lung damage will improve or worsen over time, how long it will last, and the best strategies for developing treatments.
Early evidence indicates that lung damage occurs in approximately 20% of patients discharged from hospital, but the effects on people who experience long-COVID in the community are currently unclear.
This study, led by researchers at Imperial College London, will bring together researchers and clinicians from 15 research centres, including University of Oxford scientists supported by the NIHR Oxford Biomedical Research Centre.
The study will include patients already in COVID-19 studies, such as the PHOSP-COVID study, looking at the longer-term impact of the virus.
Professor Ling-Pei Ho (left), from the University of Oxford’s MRC Human Immunology Unit, is one of the leads in the study. She said: “Studying immune cells in the lungs of patients with post-COVID lung abnormalities adds greatly to the understanding of why patients have these persistent inflammation and scarring.
“This study will be one of very few to do this and will use the latest technology to analyse these cells giving us the information of the highest resolution and potential causes for these lung problems.”
The study will initially follow up patients over 12 months, then follow longer-term outcomes through patient records.
The researchers aim to use their findings to develop treatment strategies to prevent the development of severe scarring and disability following COVID-19.
Professor Gisli Jenkins, at Imperial College London, who is leading the study, said:“This is an ambitious study that will help us understand how common and severe the long-term pulmonary consequences of COVID-19 are, and will help us develop new treatment approaches for people suffering from long-term lung inflammation as a result of COVID-19.”
“Breathlessness is a big problem for many people with long-COVID, particularly on exertion. For people with more severe lung scarring, this can be a devastating disease. We don’t yet know how frequent and how long-term the consequences will be. Even if the long-term outcomes are no worse than for people with similar lung damage from flu, the sheer numbers of people who have had COVID-19 are so huge.”
Professor Fiona Watt, Executive Chair of the Medical Research Council, part of UKRI which funded the study, said: “This research is key to understanding how and why the virus causes some people to suffer long-term lung effects after COVID-19 infection. It will be an important tool in developing more effective treatments for patients.”
To understand the full spectrum of lung impacts, the study will include a range from patients, from those who have been hospitalised or placed on a ventilator to those in the community who had less severe COVID-19.
They hope to recruit approximately 250 people with symptoms suggestive of possible lung scarring, such as breathlessness or a persistent cough, to find out more about their long-term lung damage at three and 12 months after COVID-19 infection.
Cutting-edge xenon MRI scans will be performed in a subset of patients. These use a safe, inert gas which is inhaled, so the scan can measure the effectiveness of gas exchange inside the lungs.